Total Elbow Arthroplasty Historical and Current Concepts.

The evolution of total elbow arthroplasty (TEA) has laid the groundwork for modern day TEA and has contributed to our understanding of elbow biomechanics. Trends in the usage of TEA have also varied significantly over time. This article aims to review the history and evolution of the TEA implant with a focus on modern day implant biomechanics and the trends in TEA indications. Additionally, this review discusses various complications that can occur with modern day TEA and looks toward the future to identify innovation and future trends.

The Effect of Surgical Timing on Upper Extremity Nerve Repair.

BACKGROUND: The purpose of this study was to evaluate the association between timing of nerve repair and the ability to perform a primary nerve repair versus a bridge repair requiring the use of allograft, autograft, or a conduit in lacerated upper extremity peripheral nerve injuries. METHODS: This is a retrospective case-control study of patients who underwent upper extremity nerve repair for lacerated peripheral nerves identified by Current Procedural Terminology codes. Timing of injury and surgery, as well as other information such as demographic information, mechanism of injury, site of injury, and type of nerve repair, was recorded. The odds of a patient requiring bridge repair based on the duration of time between injury and surgery was evaluated using logistic regression. RESULTS: A total of 403 nerves in 335 patients (mean age 35.87 ± 15.33 years) were included. In all, 241 nerves were primarily repaired and 162 required bridge repair. Patients requiring bridge repair had a greater duration between injury and surgery compared with patients who underwent primary repair. Furthermore, the nerves requiring bridge repair were associated with a greater gap compared with the nerves repaired primarily. Based on logistic regression, each 1-day increase in duration between injury and surgery was associated with a 3% increase in the odds of requiring bridge repair. CONCLUSIONS: There is no defined critical window to achieve a primary nerve repair following injury. This study demonstrated that nerve injuries requiring bridge repair were associated with a significantly greater delay to surgery.

Expanded Demographics for the Tillaux Fracture in Patients Receiving Feminizing Hormone Therapy A Case Report.

We present the case of a transgender female patient who had been undergoing feminizing hormone therapy for several years and sustained a Tillaux fracture despite being older than the expected age range for females with this injury pattern. Despite work focused on understanding physeal closure, the molecular signals governing this phenomenon remain incompletely described. This case study illustrates that physeal closure may be delayed in patients undergoing sex hormone therapy with associated transitional fractures possibly occurring later than would be expected for the transitional gender. Additional work is necessary to clarify the direct effect of sex hormonal therapy on physeal homeostasis.

Musculoskeletal health considerations for the transgender athlete.

BACKGROUND: In addition to the familiar sports-related injuries and conditions experienced by cisgender athletes, transgender athletes may also face unique challenges to maintaining their musculoskeletal health. Encouraging sports medicine professionals to become familiar with accepted nomenclature and terminology related to transgender athletes will enable open communication on the field, in the athletic training facility, and office. OBJECTIVE: Understanding contemporary medical and surgical gender-affirming treatments and the unique ways in which the musculoskeletal system might be affected by each - such as impairments in bone health, changes in ligamentous function and the potential increased risk for deep venous thromboembolism - is essential for provision of optimal musculoskeletal care to transgender athletes. Knowledge of the existing participation policies for transgender athletes is also key for enabling sports medicine professionals to effectively counsel athletes about the need for specialized protective equipment. Additionally, this knowledge is important for appropriately managing therapeutic use exemptions in the competitive sports setting. CONCLUSION: This article provides an overview of the current accepted nomenclature, common gender-affirming medical and surgical treatments, unique musculoskeletal health considerations, and participation policies for transgender athletes.

Opioid Prescription Patterns in Pediatric Orthopedics Following Closed Reduction and Percutaneous Pinning for Supracondylar Humerus Fractures.

BACKGROUND: There is currently an alarming upward trend in the use of prescription opioids in the pediatric population. Previous medical use of prescription opioids has shown to correlate to non-medical use of prescription opioids. To combat this, institutions have started to look at prescribing patterns to understand and eventually standardize a pain protocol to reduce unnecessary analgesics after surgery. Opioids continue to be used widely for postoperative pain control in orthopedic patients. Therefore, this study examined the prescription patterns within a large pediatric orthopedic hospital consortium after closed reduction and percutaneous pinning for supracondylar humerus fractures. METHODS: A retrospective analysis was performed in order to understand the prescribing variability in analgesics for this patient population better. Descriptive statistics and chi-squared analysis were used to evaluate for prescribing patterns. RESULTS: Narcotic medications were prescribed postoperatively to 49.6% of patients. There was no difference in narcotic prescription with length of stay or severity of fracture. Additionally, there were several documented prescribing errors, most commonly by a junior orthopedic resident. CONCLUSIONS: There is significant variability in prescribing patterns among physicians after pediatric supracondylar humerus fractures. Understanding the patterns and implementing a more standardized approach to pain control may help to combat prescribing errors.

Needle Arthroscopy Demonstrates High Sensitivity and Specificity for Diagnosing Intra-Articular Shoulder and Knee Pathology.

INTRODUCTION:  Needle arthroscopy has been introduced in recent years as an alternative to magnetic resonance imaging (MRI) for the evaluation of knee and shoulder conditions. It has continued to evolve at a rapid rate with newer generation models making in-office integration simple. As MRI can sometimes prove inconclusive, it is worthwhile to consider these alternative options for evaluating musculoskeletal pathology as a primary diagnostic tool.  Purpose: The purpose of this study is to evaluate the specificity and sensitivity of needle arthroscopy in diagnosing intra-articular shoulder and knee pathology in a small case series of patients who ultimately underwent surgical arthroscopy. METHODS: A retrospective, single-centre, single-surgeon, cohort study was performed over a three-year period from August 2018 to June 2021. During this time, diagnostic needle arthroscopy was performed on patients with suspected shoulder or knee pathology based on MRI findings and clinical exams. These patients subsequently underwent standard surgical arthroscopy. RESULTS: Thirty-four patients were included in the study. There were 35 joints included, 25 shoulders and 10 knees, with a mean age of 41.88 +/- 11.32 years and BMI of 29.33 +/- 6.27 in the shoulder group and a mean age of 45.5 +/- 14.54 and BMI of 31.5 +/- 4.94 in the knee group. When evaluating shoulder pathologies, needle arthroscopy showed a sensitivity of 0.93 for rotator cuff tears, 1.00 for labral tears and 1.00 for loose bodies. Needle arthroscopy for the shoulder was found to be 100% specific for all shoulder pathologies. Needle arthroscopy for the knee was found to have a 1.00 sensitivity for detecting chondral defects and 0.80 sensitivity for meniscal tears. There were once again no false positive needle arthroscopy findings amongst the knee group. CONCLUSION: Needle arthroscopy is an accurate diagnostic tool for the evaluation of intra-articular knee and shoulder musculoskeletal pathology. It can provide a potential solution for MRI-derived diagnostic inaccuracies that can lead to missed pathologies or unindicated procedures. It is less invasive than surgical arthroscopy and should be considered a useful tool in the armamentarium of orthopedic surgeons.